ONC drops pursuit of NwHIN governance

The Office of the National Coordinator for Health IT has dropped pursuit of a regulation for establishing “rules of the road” for the nationwide health information network (NwHIN) based on feedback it has received.

Commenters from industry and the public made it clear that federal regulation could slow development of health information exchange just as those activities are starting to emerge and pick up steam, “perhaps more than is widely appreciated,” according to Dr. Farzad Mostashari, national coordinator for health IT.

ONC issued a request for information (RFI) in May to collect public comment on a possible approach for rulemaking to spell out “conditions of trusted exchange,” including safeguards and technical and business practices. ONC wanted to receive broad input before issuing a proposed rule, he said.

ONC also considered establishing a voluntary accreditation and certification process through which to approve organizations as being legitimate participants in NwHIN, somewhat similar to the procedures for certifying electronic health records for meaningful use functions.

“Based on what we heard and our analysis of alternatives, we’ve decided not to continue with the formal rulemaking process at this time, and instead implement an approach that provides a means for defining and implementing nationwide trusted exchange with higher agility, and lower likelihood of regret,” he wrote in a Sept. 7 blog.

NwHIN is a set of comprehensive standards, services and policies that enable healthcare organizations to share information securely through the Internet.

ONC’s goal is that information follows the patient where and when it is needed, across organizational, vendor, and geographic boundaries.

But the current state of information exchange and care coordination is far from this ideal. In addition to technical challenges with interoperability, “the absence of common ‘rules of the road’ may be hindering the development of a trusted marketplace for information exchange services,” Mostashari said.

However, voluntary governance bodies are now forming both for directed and query-based exchange. ONC wants to encourage the exchange activities that are gaining steam, “and not to hobble them,” he said, especially with the expectations for standards-based exchange in stage 2 of meaningful use.

“And let me assure you that if systemic problems or market break-downs emerge that might require regulatory action, we will again seek input from the public and our stakeholders, including the Health IT Policy and Standards committees,” Mostashari warned.

Participation in the NwHIN Exchange previously was limited to federal health agencies and primarily large healthcare organizations that contract with them or are federal grantees. Agreement on how to assure conditions for trusted exchange will enable many more organizations to participate.

Among the actions that ONC will press for to promote trusted exchange are:

• Identify and shine a light on good practices that support secure and interoperable exchange and provide a guide for evolving governance models

• Learn from and engage with groups in governance and oversight roles for exchange partners in order to foster models within and across communities

• Continue to use existing authorities and convening powers to create consensus and provide guidance and tools around specific barriers to interoperability and exchange

• Evaluate how and what consumer protections can be appropriately applied to health information exchange through existing regulations

• Monitor and learn from the wide range of activities that are occurring.